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中华结直肠疾病电子杂志 ›› 2015, Vol. 04 ›› Issue (06) : 607 -612. doi: 10.3877/cma.j.issn.2095-3224.2015.06.07

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腹腔镜主导下个体化肛提肌切除的APE术
冯波1, 卢矫阳1, 郑民华1,()   
  1. 1. 200025 上海交通大学医学院附属瑞金医院普外科 上海市微创外科临床医学中心
  • 收稿日期:2015-10-15 出版日期:2015-12-25
  • 通信作者: 郑民华
  • 基金资助:
    2011上海市科委重点项目(11411950700); 国家高技术研究发展计划(863项目)(2012AA021103); 2012上海市卫生局重点项目(20130423); 2013上海交通大学医工交叉面上项目(YG2013MS26); 2013上海市卫生系统先进适宜技术推广项目(2013SY010)

Laparoscopic-cotrolled abdominaoperineal excision with individualized levator muscle transection

Bo Feng1, Jiaoyang Lu1, Minhua Zheng1,()   

  1. 1. Depatment of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
  • Received:2015-10-15 Published:2015-12-25
  • Corresponding author: Minhua Zheng
  • About author:
    Corresponding author: Zheng Minhua, Email:
引用本文:

冯波, 卢矫阳, 郑民华. 腹腔镜主导下个体化肛提肌切除的APE术[J]. 中华结直肠疾病电子杂志, 2015, 04(06): 607-612.

Bo Feng, Jiaoyang Lu, Minhua Zheng. Laparoscopic-cotrolled abdominaoperineal excision with individualized levator muscle transection[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2015, 04(06): 607-612.

对于低位直肠癌的手术治疗,传统腹会阴部联合切除术存在穿孔率和环周切缘阳性率高的问题,预后较差。肛提肌外腹会阴联合切除术通过扩大切除带来的肿瘤学获益仍有争议,且该手术创伤大,并发症发生率较高。本文回顾两项手术发展历史,评价相关循证医学证据,并提出一种腹腔镜主导下的腹会阴联合切除术。该手术在腹腔镜直视下经盆腔途径个体化切除肛提肌,将其最大程度保留用于盆底重建;将手术汇合平面降至坐骨直肠窝脂肪,简化会阴部操作;并具备腹腔镜手术操作精细,利于盆部自主神经保护的传统优点,是一种值得在实践中进一步完善推广的新术式。

In the field of surgical treatment for low rectal cancer, the traditional abdominoperineal excision (APE) do not benefit much from the total mesorectal excision (TME) prinple, but is trapped by the so-called ?surgical waist? and associated oncological inferiorities. The safety of a more radical procedure, the extralevator abdominoperineal resection (ELAPR) is still under debate. Owing to the advancement of laparoscopic techniques, we developed a laparoscopy-cotrolled APE (LCAPE) procedure for stage I-III patients. During the procedure, a controlled incision of levators into the ischiorectal fat was performed transabdominally under direct vision; the meeting plane is therefore lowered and the perineal dissection simplified without changing body position. This laparoscopic guided technique has innate advantages in neurovascular preservation, and offers individualized transection of levator muscles, minimizes the risk of wound complications and prevents surgical waist to ensure oncological safety.

表1 APE和AR的肿瘤学效果对比表(%)
表2 最新APE与ELAPE手术短期与长期效果比较表(%)
表3 腹腔镜与开腹直肠癌远期疗效RCT研究比较表(I级证据)
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